Is the grass really greener?Reflections on ST4 in Australia
Tasmania not Tansania...
Tasmania not Tansania...
Royal Hobart Hospital
Population of 500,000
250,000 in Hobart
Approx 500 beds
Trauma and tertiary referral centre for
just about anything
Approx 160 presentations a day
Shifting targetsThe UK is not alone
> 5% year on year increase in
patient numbers
Increasing social care needs
Overcrowding in ED not
acknowledged as a hospital
wide problem
Workload and supportApprox 40 hour week
Roughly 8-16 patients a shift
Consultant cover from 8am to 11pm every day
Critical care
More procedures
Certifying deaths
PENs - amazing!
Aides but no HCAs less ENPs
EMAT
Ultrasound
CT in ED
Lipase
BNP
There is only one emu in tasmania...10 bed unit
Aim to discharge within 24 hours
<15% conversion rate
Set proformas for common uses e.g.
anaphylaxis
Very popular with inpatient teams
Training and WBPAs4 hours teaching a week
Increasingly SIM focused
Combined with departmental feedback
Significantly less WPBAs
Shift report similar to ESLE
Dedicated registrar office
The dreaded private sectorED consultants and registrars
Approx 60 patients a day
More time with patients
Less hostility
Free lunch!
Greater patient satisfaction
And a few
cases that will
stick with me
Cases49 year old paramedic who rescues
snakes in his spare time - bitten by snake…
35 year old recreational diver with intense hip pain…
71 year old single gunshot wound to the face / neck. Arrested on route, required surgical airway…
45 year old set on fire by her husband, approx 40% and airway burns…